INDEX [miningquiz.com]



NOTICE

This template is not an NSSGA work product, nor is it endorsed by NSSGA.

This template is offered in the spirit of operator cooperation by Martin Stone Quarries, Inc.

Please use and edit this file as you choose.

At the very least, “control find” in your MS Word program will allow you to replace “ABC Company, Inc.” with your company name.

As always, you will be responsible for the end result document and you may want to seek review by counsel prior to implementation.

ABC COMPANY, INC.

Drug Free Work Place Guidelines

INDEX

01 INTRODUCTION: Policy Statement and Summary

04 SECTION 1 - Purpose

04 SECTION 2 - Applicability

05 SECTION 3 - Definitions

05 SECTION 4 - Test/Searches

06 SECTION 5 - Drug/Alcohol Testing

07 SECTION 6 - Testing Procedures

08 SECTION 7 - Prohibited Conduct

09 SECTION 8 - Consequences

09 SECTION 9 - Searches

10 SECTION 10 - Employee Assistance

11 SECTION 11 - Training

Appendices

12 A - Employee Acknowledgment Form

13 B - Continued Employment Agreement

14 C - Agreement to Treat

15 D - Testing Information/Medical Review Officer

INTRODUCTION: DRUG AND ALCOHOL ABUSE POLICY STATEMENT

AND

POLICY SUMMARY

ABC COMPANY, INC. has long recognized that drug and alcohol abuse pose a serious threat to the safety, health and welfare of our employees and those with whom we do business, and that such abuse by our employees also threatens our economic viability and our business reputation. In January of 1990, it became the goal of this organization to achieve and maintain a workplace free from the effects of substance abuse.

Although we have no intention of unduly intruding into the private lives of our employees, we recognize that involvement with alcohol or drugs on or off the job eventually takes its toll on employee safety and job performance. Our primary goal is to ensure that employees report to work in condition to perform their duties safely and efficiently in the interest of their fellow workers and customers as well as themselves.

The goal of this policy is to balance our respect for individuals with the need to maintain a safe, productive and drug-free environment. The intent of this policy is to offer a helping hand to those who need it, while sending a clear message that the illegal use of drugs and alcohol is incompatible with employment at ABC COMPANY, INC.

Highlights of the major provisions of this policy are as follows:

Therefore,

1. All employment applicants will be offered employment conditioned upon successfully passing a drug and alcohol test, and will not be permitted to commence employment until the results of such tests are received and the applicant has met all other employment requirements outlined by Human Resources. Further, all employment applicants will be offered employment conditioned upon their agreement to automatic referral of positive test results to appropriate government agencies, in any case of post incident testing.

2. All employees returning to work from layoff, or any other leave that exceeds thirty calendar days, must successfully pass a drug and alcohol test before being allowed to return to work and must meet all other employment requirements as outlined by Human Resources.

3. The company shall conduct post accident testing of all employees when the accident results in employee injury requiring medical treatment from a licensed physician or, in the opinion of a trained first aid responder, the employee is instructed to seek additional medical treatment from a licensed physician, or when the accident results in total property damage of $1,000.00, or injury to company property and employees as well as property damage and injury to non-employees. All employees for whom, in the sole judgement of trained supervisors or managers, there is a reasonable suspicion or cause to believe that the employee has violated our substance abuse policy are also subject to testing and discipline as outlined in this policy.

Due to the possibility of impairment, work may not be resumed until a negative test result is received.

4. The company shall conduct random drug tests as a member of a recognized consortium and will follow all directives of said consortium, to successfully maintain a random testing program.

5. Violations of this policy are subject to disciplinary action outlined in this policy.

A refusal to consent to testing or provide a valid sample or other conduct that obstructs the testing process will be considered a withdrawal of the applicant’s employment application and a violation of this policy.

Prohibited Conduct, This organization strictly prohibits the following conduct:

1. ILLEGAL DRUGS

The illegal sale, manufacturing, distribution, dispensing, use, possession, purchase, obtaining, or being under the influence of any illegal drug or misuse of controlled prescription drugs at any time (whether on or off-duty) or while on-the-job (regardless of the location), or while representing the organization in any capacity -- whether on or off-duty.

2. PRESCRIPTION DRUGS

While on-the-job, being under the influence of legally obtained and used prescription drugs that affect the individual’s functioning in such a way as to jeopardize the safety of the individual or others or to substantially impair job performance, if the employee has failed to notify management that he or she is using such a prescription. Every employee who is issued a prescription drug has an obligation to ask the prescriber whether the medication, if used properly, will affect the individual’s function in such a way as to jeopardize the workplace safety of the individual or others, or will significantly impair job performance. If so, the employee has an obligation to report that situation to management.

3. OVER-THE-COUNTER DRUGS

While on-the-job, being under the influence of over-the-counter drugs used contrary to the product’s labeling (i.e. misuse of over-the-counter drugs) that affect the individual’s functioning in such a way as to jeopardize the safety of the individual or others or to substantially impair job performance. Some over-the-counter drugs, even when used properly, will affect the individual’s function in such a way as to jeopardize the workplace safety of the individual or others, or will significantly impair job performance. If so, the employee has an obligation to report that situation to management.

6. ALTERNATIVE SUBSTANCES (DESIGNER DRUGS)

While on-the-job, being under the influence of any chemical or substance used contrary to the product’s labeling that affect the individual’s functioning in such a way as to jeopardize the safety of the individual or others or to substantially impair job performance. This includes but is not limited to glue, butane, liquid lighter fluid, liquid eraser, and et. al.

5. ALCOHOL

Being under the influence of alcohol at the worksite (whether on or off-duty or during lunch and breaks) or while on-the-job (regardless of the location).

• Use of alcohol at the worksite (whether on or off-duty or during lunch or breaks) or while on-the-job (regardless of the location).

• Possessing containers of alcohol on the job, regardless of location.

RULES REGARDING DRUGS AND ALCOHOL

This summary is meant to highlight the major points of the enclosed policy. To the extent that there are inconsistencies between the summary and the policy, the policy itself controls. No deviation from this policy will be permitted without the prior express authorization of Senior Management and the General Counsel.

THE DRUG FREE WORK PLACE POLICY

Section 1 - Purpose

This organization is committed to protecting the safety, health, and well being of its employees and all people who come into contact with its workplace(s) and property, and/or use its products and services. Recognizing that drug and alcohol abuse pose a direct and significant threat to this goal, and to increase confidence in our business and services provided, this organization is committed to creating a drug free working environment for all of its employees.

Additionally, recognizing other adverse legal, economic, and social consequences of substance abuse, this policy is adopted and enforced in order to:

Deter illicit drug and alcohol use on-the-job.

Deter illicit drug use off the job.

Ensure that employees are fit for duty.

Identify employees who have substance abuse problems that affect job performance and assist them in obtaining help.

Maintain high morale among those many valuable employees who do not engage in substance abuse.

Maintain high quality goods and services.

Maintain its effectiveness.

Provide a role model to those individuals or organizations that it serves.

This policy statement does not create an employment contract or otherwise limit this organization’s management rights, including the right to change this policy.

SECTION 2 - APPLICABILITY

This policy applies to all employees, whether full or part-time, and whether temporary or permanent, at all levels within the organization. It applies to employees hired for a specific period of time, such as seasonal employees. The testing procedures and requirements outlined in this policy do not apply to employee drivers with a commercial driver’s license. Testing procedures for these employees are conducted as required by the Department of Transportation.

Further, I understand that I have agreed and will allow ABC COMPANY, INC. to refer positive test results to appropriate government agencies, in any case of post incident testing.

Additionally, the prohibited conduct section of this policy is also applicable to contractors, sub-contractors or individuals hired on a temporary basis through employment agencies. It is the policy of this organization to encourage these service providers to adopt and maintain their own drug free workplace policies and programs. In choosing such service providers, preference will be given to those businesses that have a substance abuse policy similar to this policy. Violations of the prohibited conduct section of this policy shall be grounds for terminating any contract or sub-contract or arrangement for temporary service.

As specifically delineated in ‘Prohibited Conduct’ of this policy, this policy governs conduct while on work premises, whether on or off-duty, and while on-duty, regardless of the location. It also applies to conduct that is off-duty if it is illegal, involves substance abuse, (as defined below) and in the sole judgment of management is likely to undermine the public confidence in or harm the reputation of the organization.

SECTION - 3 - DEFINITIONS

“Drugs” include, without limitation, narcotics, marijuana, hashish, heroin, hallucinogens, depressants, cocaine, and all other controlled substances enumerated in Schedules I through V of the Controlled Substances Act, 21 U.S.C. §812 et seq., and in the federal regulations promulgated thereunder, and medication other than those sold to the public on a non-prescription basis and those that are prescribed to the employee by a duly licensed physician. This definition includes “look alike” and “designer” drugs. In addition, to the extent that they are not utilized for the primary purposes for which they were manufactured but are instead used for the purposes of altering one’s mood, perception, pain tolerance level, or judgment, any chemical substance will be considered to be a drug under this definition, including but not limited to glue and liquid eraser.

An employee will be considered “under the influence” if he/she has a blood alcohol concentration of 0.02 percent or more by weight of alcohol in his/her blood.

The terms “alcohol” or “alcoholic beverages” mean any substance having an alcoholic content equal to or in excess of the percentage by volume considered under the applicable state law as constituting “liquor”, “alcohol” or an “alcoholic beverage”, including but not limited to beer, ale, wine, whether fermented naturally fermented, blended, fortified or otherwise, distilled liquors of any sort, or any mixture of the above.

The terms “premises” or “ABC COMPANY, INC. premises” mean all property owned, rented, leased or controlled by ABC COMPANY, INC. or its affiliates or subsidiaries, including all facilities, land, buildings, structures, and all other real estate, and motor vehicles.

SECTION 4 - TESTING AND SEARCHES

To the extent considered necessary for the safe and productive conduct of ABC COMPANY, INC. business and the safety and health of ABC COMPANY, INC. employees, drug and alcohol testing and searches may be performed. Such action may be taken when ABC COMPANY, INC. reasonably believes or suspects that there may be an alcohol or drug-related problem pertaining to job performance, including, but not limited to safety, productivity, quality of work, health or attendance, to determine whether an employee is in possession of or under the influence of alcohol or drugs, or has the presence in his/her system of drugs while on ABC COMPANY, INC. business anywhere or ABC COMPANY, INC. premises.

In cases where a drug or alcohol test is required, failure to submit to testing or failure to comply with testing procedures (sample tampering, employee release, etc.) will result in the employee’s discharge. In cases where a search is required, if the results of the search show possession, the employee will be discharged. If the results of a drug or alcohol test confirm that the employee was under the influence of drugs or alcohol, he/she will be subject to discharge. If the results of the testing show presence of a drug or its metabolites used in violation of this Policy, the action that ABC COMPANY, INC. will take will depend upon the totality of the circumstances, and the test results will be considered as one factor in determining what action will be taken, such as referring the individual for appropriate assistance. In such cases, the employee will be subject to and must sign the Continued Employment Agreement.

For purposes of requiring drug and alcohol testing or searches under this Policy, ABC COMPANY, INC. defines a “reasonable belief or suspicion” as a basis for forming a belief based on specific facts and rational inferences drawn from those facts.

Specific situations which may lead to testing and/or searches include, but are not limited to:

• Random testing - done on a periodic basis through membership in a bona fide drug testing consortium.

• Incident on Duty - An employee who becomes involved while on ABC COMPANY, INC. business or on ABC COMPANY, INC. premises in an incident which endangers or adversely affects a person or property may be asked to submit to alcohol and drug testing and/or a search.

• Accident on Duty – ABC COMPANY, INC. shall conduct post accident testing of all involved employees when said accident takes place on ABC COMPANY, INC. premises, or involves ABC COMPANY, INC. property, or while in the course of conducting ABC COMPANY, INC. business, if the accident results in an injury requiring medical treatment from a licensed physician or, in the opinion of a trained first aid responder, the injured is instructed to seek additional medical treatment from $1,000.00 or more. All employees for whom, in the sole judgement of trained a licensed physician, or when the accident results in total property damage of supervisors or managers, there is a reasonable suspicion or cause to believe that the employee has violated our substance abuse policy are also subject to testing and discipline as outlined in this policy.

• Unfit Condition - If an employee on ABC COMPANY, INC. business or on ABC COMPANY, INC. premises is observed to be in an unfit condition (i.e., not capable of performing work in a normal, safe or productive manner), he/she may be asked to submit to drug and alcohol testing and/or a search.

Due to the possibility of impairment, any employee required to submit to drug/alcohol testing post accident, post incident, or due to possible unfit condition will not be allowed to return to duty until a negative test result is received. In the event that a disciplinary suspension has been imposed due to inappropriate action surrounding or precipitating the accident or incident, suspension may begin effective the first day the employee was not allowed to return to the duty station. In the event that a positive test result is received, the entire incident will be re-evaluated for possible additional action.

SECTION - 5 - DRUG AND ALCOHOL TESTING

The Director of Human Resources will insure that sampling is done in accordance with applicable state and federal laws and regulations, and with due regard for an individual’s expectation of privacy. In the event that said testing must be done outside the supervision of the Director of Human Resources, a pre-determined medical facility will be used (Lehigh Valley Hospital Center and or its industrial medicine affiliate, AFFINITY, Inc ., or any other qualified facility that may be appointed by the Director of Human Resources.)

Custody Procedure - Each location must maintain a documented chain of custody procedure. Further, each location must assure that any laboratory used maintains a documented chain of custody procedure. Split-sampling and/or sample preservation for confirmation will be used.

SECTION 6 - TESTING PROCEDURE

• Alcohol - The test for alcohol will be either by a blood, breath or saliva test. Blood tests will be confirmed by a second blood test. Breathalyzer tests will be confirmed by blood tests. Either Breathalyzer or blood test will confirm saliva tests. If the employee refuses a confirmation test, the employee must be advised that any decisions regarding policy violations will be based upon the results of the initial test.

• Drugs (urinalysis) - The initial test will be immunoassay. If the immunoassay test results are negative, no further testing will be required. However, if the immunoassay test result is positive, a second test, gas chromatography/mass spectrometry (GCS/MS), must be made for confirmation before the employee is subjected to the terms of this Policy.

• The Medical Director will determine and set the appropriate levels at which each urine specimen will be assayed for the presence of drugs.

An employee or applicant with a confirmed positive test result will meet with the Director of Human Resources and will be given the opportunity to explain such result by presenting any information he/she considers relevant. An employee who has a confirmed positive drug test will be given up to 24 hours to choose one of the following:

• agree to be evaluated by the E.A.P. as outlined in Section 10, or

• resign his/her position, or

• recheck the original urine specimen at his/her own expense. However, laboratory criteria requires that such action must be taken within seventy-two (72) hours of the employee’s notification of the test result.

Testing Methods - ABC COMPANY, INC. reserves the right to use other testing methods and procedures, as they become available. New testing methods and procedures will be recommended by the Director of Human Resources and approved by Senior Management and General Counsel.

As specifically delineated in the ‘Prohibited Conduct’ section of this Policy, this policy applies to:

Illegal drugs.

Illegal conduct with regards to prescription drugs that altar mood or impairs functioning. (Controlled substances)

Illegal or improper conduct with regards to any chemical used to alter mood or impair functioning.

Any employee convicted of a criminal drug statute violation occurring in the workplace must advise ABC COMPANY, INC. within five (5) days of said conviction.

Work-related abuse of over-the-counter medicines that alter mood or impair functioning.

Work-related alcohol conduct.

Illegal alcohol-related conduct.

Illegal conduct with regards to any chemical used to alter mood or impair functioning

Collectively these items are referred to in this policy as “substance abuse.”

SECTION 7 - PROHIBITED CONDUCT

This organization strictly prohibits the following conduct:

• (ILLEGAL DRUGS)

The illegal sale, manufacturing, distribution, dispensing, use, possession, purchase, obtaining, or being under the influence of any illegal drug or misuse of controlled prescription drugs at any time (whether on or off-duty) or while on-the-job (regardless of the location).

The sale, manufacturing, distribution, dispensing, use, possession, purchase, obtaining, or being under the influence of illegal drugs while representing the organization in any capacity -- whether on or off-duty.

• PRESCRIPTION DRUGS

While on-the-job, being under the influence of legally obtained and used prescription drugs that affect the individual’s functioning in such a way as to jeopardize the safety of the individual or others or to substantially impair job performance, if the employee has failed to notify management that he or she is using such a prescription. Every employee who is issued a prescription drug has an obligation to ask the prescriber whether the medication, if used properly, will affect the individual’s function in such a way as to jeopardize the workplace safety of the individual or others, or will significantly impair job performance. If so, the employee has an obligation to report that situation to management.

• OVER-THE-COUNTER DRUGS

While on-the-job, being under the influence of over-the-counter drugs used contrary to the product’s labeling (i.e. misuse of over-the-counter drugs) that affect the individual’s functioning in such a way as to jeopardize the safety of the individual or others or to substantially impair job performance. Some over-the-counter drugs, even when used properly, will affect the individual’s function in such a way as to jeopardize the workplace safety of the individual or others, or will significantly impair job performance. If so, the employee has an obligation to report that situation to management.

• “DESIGNER” DRUGS

While on-the-job, being under the influence of any chemical or substance used to alter mood or impair function in such a way as to jeopardize the workplace safety of the individual or others, or will significantly impair job performance. Prohibition includes but is not limited to glue, butane, liquid lighter fluid, liquid eraser, and et.al.

ALCOHOL

Being under the influence of alcohol at the worksite (whether on or off-duty or during lunch and breaks) or while on-the-job (regardless of the location).

Use of alcohol at the worksite (whether on or off-duty or during lunch or breaks) or while on-the-job (regardless of the location).

Possessing containers of alcohol on the job, regardless of location.

SECTION 8 - CONSEQUENCES

Any violations of this policy:

May result in disciplinary action up to and including termination.

May result in termination for new employees enrolled in a probationary period.

Will result in enrollment and successful completion of a substance abuse program, approved by ABC COMPANY, INC. and completing all requirements of the attached continued employment agreements for employees not subject to the probationary period.

Will allow ABC COMPANY, INC. to refer positive test results to appropriate government agencies, in any case of post incident testing.

This organization recognizes that substance abuse by an individual may indicate that the individual is suffering from a medical condition that may be successfully treated. At the same time, however, this organization cannot and will not tolerate violations of this Drug Free Workplace Policy.

Therefore, it is the philosophy of this organization, whenever possible, and consistent with the interests of the organization and the health and safety of all its employees, to allow individuals in need of treatment and/or rehabilitation an opportunity to obtain help, and to return to work without loss of job privileges. At the same time, however, the individual will be held accountable for his or her behavior and work performance and may be subject to disciplinary action for policy violation.

Absent extenuating circumstance, violations of this policy that, if proven, would constitute a felony will result in termination and referral for prosecution. For this sanction to be applied, however, it is not necessary for criminal charges to be brought or for a conviction to occur. This sanction may be applied when, in the judgment of management, there is reasonable grounds to believe that the felony-type violation has been committed.

SECTION 9 - SEARCHES

Consenting to a search and cooperating in the company’s investigation are a condition of employment. Entry into any job site or this organization’s premises constitutes consent to search and inspections.

When this organization has any reason to believe that an employee is violating any aspect of this policy while at the worksite, the employee may be asked to submit immediately to search or inspection.

This includes a search of an employee’s locker, desk, workstations, vehicles, or any other property he or she uses, or has access to.

An employee’s refusal to consent to a search or inspection when requested constitutes a violation of this Drug Free Workplace Policy and will subject the employee to the consequences for violations given in Section 4 above.

Search - Each facility manager must notify its employees that they and their property may be subject to search for drugs and alcohol while on ABC COMPANY, INC.’ premises. Searches must be approved in advance by the facility manager or his/her designee.

There must be reasonable suspicion to believe that a problem under this Policy has occurred before a search is initiated.

Employees should be notified that desks, lockers, cabinets, drawers, computers and computer applications, including electronic mail, that they use are the property of ABC COMPANY, INC. and, if necessary from time to time, may be searched. If the employee has placed a personal lock on or limited access to any such locker, desk, cabinet, computer etc., he or she may be asked to remove it or, if the employee is not available or otherwise refuses such a request, it may be removed for the employee.

Employees must give consent before being personally searched (pockets emptied, purses opened, etc.). Searches will not consist of unnecessary physical contact. Refusal to consent could result in discipline up to and including termination of employment. Such searches should be carried out in privacy, but with a witness selected by the supervisor or other authorized employee conducting the search.

When property belonging to or used by an employee on ABC COMPANY, INC.’ property (including a motor vehicle) is to be searched consent should be sought, but is not required. If possible, the employee should be notified of the search and should be present. Employees who fail to grant such consent or otherwise cooperate with the search, may be disciplined up to and including termination of employment. The search should be carried out in privacy, but with a witness selected by the supervisor or other authorized employee conducting the search.

Contraband found must be placed into properly marked containers. Transport should be by police or other personnel authorized to be in possession of the substance during transport. Testing of the contraband should be by a recognized laboratory.

Questioning - When there is reasonable suspicion to believe a problem under this Policy has occurred, the employee may be questioned.

Questioning must be non-threatening, and it must be conducted in private.

There may not be any involuntary detainment associated with the questioning, and the employee’s request for the presence of a co-worker witness must be granted.

Employees who refuse to participate in the questioning may be disciplined up to and including termination of employment.

SECTION 10 - EMPLOYEE ASSISTANCE PROGRAM

This organization has provided for an Employee Assistance Program (E.A.P.). When an employee tests positive on a required drug/alcohol screening and the results have been verified or has been convicted of a criminal drug/alcohol offense, the company will require an evaluation through the company’s E.A.P. and may require the employee to complete a substance abuse rehabilitation program acceptable to the company. The employee consent form is titled “Appendix C” and is a part of this policy. Any employee who is referred to seek treatment as part of a disciplinary process for violations of this policy who refuses to participate in the assistance program, to follow through with its recommendation, or to complete successfully the recommended course of action may be subject to additional discipline up to and including termination.

SECTION 11 - MANAGEMENT TRAINING

All employees in management positions shall (1) become familiar with the ABC COMPANY, INC.’ Alcohol and Drug Abuse Policy and Procedure, (2) participate in supervisory training programs developed by ABC COMPANY, INC. to assist them in performing their responsibilities under this Policy, and (3) take the steps necessary to ensure that those managers and supervisors in the organization with the need-to-know also participate in training programs and become familiar with the Policy. Such management and supervisory training shall include, at a minimum, behavioral observation training and drug and alcohol use education, including identification of drugs of abuse and the characteristics of their use.

APPENDIX A

SUBSTANCE ABUSE WORKPLACE POLICY ACKNOWLEDGMENT FORM

I have received, read and agreed to comply with ABC COMPANY, INC. Substance Abuse Policy as a condition of employment. Further, I understand that I have agreed and will allow ABC COMPANY, INC. to refer positive test results to appropriate government agencies, in any case of post incident testing.

I further understand that this policy is not a contract and does not create employment rights and that ABC COMPANY, INC. may change the policy at any time.

Employee’s Printed Name: ______________________________________________________

Employee’s Signature:__________________________________________________________

Supervisor’s Printed Name:______________________________________________________

Supervisor’s Signature:_________________________________________________________

Date:__________________________

APPENDIX B

CONTINUED EMPLOYMENT AGREEMENT

I understand that ABC COMPANY, INC. has agreed to continue my employment provided that I meet and satisfy each of the following conditions:

1. I must immediately enroll in and successfully complete a treatment program or plan approved by ABC COMPANY, INC..

2. If my treatment includes in-patient treatment, I will report for an appropriate work assignment promptly on completion of the in-patient program. I recognize that my continued employment is based upon the availability of a position and the business needs of ABC COMPANY, INC. unless my absence for treatment constituted medical leave under the Family Medical Leave Act. In that case, I will return to my position or an equivalent position, unless my position has been eliminated.

3. During the twenty-four (24) months following my return to work, I agree to allow and will promptly comply with ABC COMPANY, INC.’ requests to conduct follow-up drug and alcohol testing and searches on an unannounced basis. I understand that the follow-up testing and searches are due to the fact that I violated ABC COMPANY, INC.’ policy and could have been terminated for that violation. I understand that I will be subject to termination if I test positive on any such drug or alcohol test or if any search uncovers the unauthorized possession of drugs or alcohol.

4. I agree to participate in and complete any follow-up programs and/or treatment that are deemed necessary by the counselors approved by ABC COMPANY, INC..

5. I will cooperate with ABC COMPANY, INC. in disclosing information concerning my progress in and completion of the required treatment program or plan and follow-up treatments.

6. I understand that the ABC COMPANY, INC.’ policy regarding drug and alcohol use is designed to promote the health and safety of all employees and to maintain a safe, healthful, and efficient workplace.

I understand that if I fail to satisfy any of the conditions listed above, I will be terminated. I also understand that this Agreement does not create a contract of employment for any duration and does not modify my status as an at-will employee, and that either ABC COMPANY, INC. or I may terminate my employment without cause and without notice. I further understand that in addition to the conditions set forth above, I must abide by all other ABC COMPANY, INC.’ regulations and policies.

Employee’s Printed Name: ______________________________________________________

Employee’s Signature:__________________________________________________________

Supervisor’s Printed Name:______________________________________________________

Supervisor’s Signature:_________________________________________________________

Date:__________________________

APPENDIX C

AGREEMENT TO UNDERGO DRUG AND ALCOHOL TREATMENT

I have voluntarily requested an opportunity to participate in a drug and alcohol treatment program or plan approved by ABC COMPANY, INC.. Upon my successful completion of such treatment program or plan, I will be permitted to resume my employment with ABC COMPANY, INC. subject to the following conditions:

1. I will cooperate with ABC COMPANY, INC. in disclosing information concerning my progress in and completion of the required treatment program or plan and follow-up treatments.

2. If my treatment includes in-patient treatment, I will report for work promptly after completion of the in-patient program. ABC COMPANY, INC. will make very reasonable effort to return me to my former position following the completion of my treatment. If my absence for treatment constituted medical leave under the Family Medical Leave Act, ABC COMPANY, INC. will return me to my position or an equivalent position, unless my position has been eliminated.

3. During the twenty-four (24) months following my return to work, I agree to allow and will comply with unannounced ABC COMPANY, INC.’ requests to conduct follow-up drug and alcohol testing. I understand that I will be subject to termination if I test positive on any such drug or alcohol test. I further understand that this unannounced, follow-up testing is intended to help me refrain from drug and alcohol abuse.

4. I agree to participate in and complete any follow-up treatment that is deemed necessary by the counselors approved by ABC COMPANY, INC..

I understand that if I fail to satisfy any of the conditions listed above, I will be terminated. I also understand that this Agreement does not create a contract of employment for any duration and does not modify my status as an at-will employee, and that either ABC COMPANY, INC. or I may terminate my employment without cause and without notice.

Employee’s Printed Name: ______________________________________________________

Employee’s Signature:__________________________________________________________

Supervisor’s Printed Name:______________________________________________________

Supervisor’s Signature:_________________________________________________________

Date:__________________________

APPENDIX D

SECTION 1.

Recognizing that substance abuse poses a serious threat to the well being of our employees and our economic viability, this organization conducts drug testing in order to:

Protect the safety, health, and well being of all its employees.

Comply with provisions of certain contracts or grants.

Deter the illegal use of drugs and alcohol use on-the-job.

Deter the illegal use of drugs off the job.

Ensure that employees are fit for duty.

Identify employees who have substance abuse problems that affect job performance and assist them in obtaining help.

Maintain high morale among those many valuable employees who do not engage in substance abuse.

Maintain high quality goods and services.

Protect the safety of the public and/or consumers who the organization serves or to whom it provides goods.

Maintain consumer confidence in the organization’s work product.

Maintain its economic viability and vitality.

Maintain its effectiveness.

Provide a role model to those individuals or organizations that it serves.

Protect its property, equipment, and operations.

Identify employees who have violated its drug free workplace policy.

SECTION 2. SCOPE OF TESTING

In order to achieve the above stated purposes, this organization shall conduct testing for alcohol and illicit drugs including, but not limited to:

Alcohol

• Drugs, (5 panel): Cannabinoids (THC--Marijuana), Cocaine (Coke, Flake, Snow, Crack), Phencyclidine (PCP, Angel Dust, Hog), Opiate (Heroin, Morphine, Codeine), Amphetamines (Methamphetamines, Benzedrine, Dexedrine)

• Drugs, (10 Panel), Benzodiazepine (Valium, Librium, Xanax), Barbiturate (Nembutal, Seconal, Black Beauties), Propoxyphine (Darvon, Darvocet, Dolene), Methadone (Dolephine), Methaqualine (Quaalude)

SECTION 3 - SANCTIONS FOR REFUSAL TO BE TESTED OR FOR TAMPERING WITH THE TEST.

Consenting to drug testing under the circumstances enumerated in this policy is a condition of obtaining employment and of continuing employment. Any job applicant who refuses to be drug tested or who tampers with the test will not be hired. Any employee who refuses to be drug tested or who tampers with the test:

will be considered to be in violation of our drug free workplace policy and subject to sanctions pursuant to that policy.

SECTION 4 - DRUG TESTING PROCEDURES

Testing procedures for alcohol and drugs are outlined in Section 4 of the policy.

An initial screening will be conducted using:

• ACT Lab Services (pre-employment and random drug testing)

Q.E.D. A150 Saliva Alcohol test (alcohol-post incident)

LVHC Toxicology Lab (drugs - post injury)

For samples that are found to be positive by the initial screen, the sample will be re-tested using a different more sensitive chemical technique. If this verification test reveals that the sample contains drugs at levels pre-determined by management to constitute positive test results, the results will be reviewed by a Medical Review Officer (MRO). At all times procedures will be followed to insure proper chain of custody of the specimen.

EMPLOYEE VERIFICATION

We do not provide for employee-directed verification of positive drug test results.

SECTION 5 - CONFIDENTIALITY

All records regarding whether and when a drug test was conducted and the results are confidential. They shall be maintained in secured files under the control of the Director of Human Resources. The results of all drug tests shall be revealed only to management personnel with a need to know.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download